Cancelled Apt Notification

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,understand that it is the policy at Family Services Center to charge a no show fee to clients who do not cancel their appointments 24 hours prior to their scheduled appointment. This fee will be $25.00 and will need to be paid prior to being seen again.


I further understand that if I fail 2 or more appointments, I will not be allowed to schedule another appointment until I pay the no show fees. I will also be expected to pre-pay for my next appointment.

, give consent for the staff at Family Services Center to use the following contact information for reminders about upcoming appointments. By providing a phone number, I give permission to leave a voice mail regarding appointment dates and times. Information sent via email will generally be limited to appointment information; however it may also be used to follow up in the event of a missed appointment.

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